International Journal of Osteopathic Medicine (2015) 18, 50e62

www.elsevier.com/ijos

RESEARCH REPORT

Adapting and feasibility testing pre-

registration e-learning resources for
Professionalism in Osteopathy in the UK
Fiona Browne a,*, Kerstin Rolfe b,c, Alan Currie a,d,
Tim Walker a,e, Sue Roff a,e

a
General Osteopathic Council, Osteopathy House, 176 Tower Bridge Road,
London SE1 3LU, UK
b
British College of Osteopathic Medicine, Lief House, 120 e 122 Finchley Road,
London NW3 5HR, UK

Received 23 June 2013; revised 29 July 2014; accepted 1 August 2014

KEYWORDS Abstract Background: The UK General Osteopathic Council (GOsC) has statutory
Assessment; duties of ‘promoting high standards of education and training in osteopathy and
E-learning; keeping the provision of that training under review’. Students graduating from oste-
Learning; opathic educational institutions (OEIs) must meet the GOsC Osteopathic Practice
Osteopathy; Standards.1
Professionalism; Objectives: One domain within the Osteopathic Practice Standards is ‘professional-
Regulation; ism’. Supporting guidance requires explicit teaching and learning opportunities about
Teaching ‘professionalism’ in osteopathy. Our objectives are to establish the feasibility of adapt-
ing e-learning resources used widely in medical education to meet these requirements.
Methods: A consensus group of two senior faculty representatives nominated by their
Deans or Principals from each of the 11 UK OEIs and senior officers from the GOsC, with
expertise in standards, reviewed and adapted the items of the two Dundee Polyprofes-
sionalism resources used to explore professionalism in medical education. Four addi-
tional items were added. The agreed inventory was tested on two groups of 4 and 12
osteopathy students.
Results: The adaptation and feasibility of 34 items for Professionalism in Osteopathy 1
(Academic) and the 45 items for Professionalism in Osteopathy 2 (Clinical) were agreed
to explore professionalism in osteopathy.

* Corresponding author. Tel.: þ44 020 7357 6655x239.

E-mail address: fbrowne@osteopathy.org.uk (F. Browne).
c
Tel.: þ44 020 7435 6464.
d
Tel.: þ44 020 7357 6655x251.
e
Tel.: þ44 020 7357 6655x239.

http://dx.doi.org/10.1016/j.ijosm.2014.08.002
1746-0689/ª 2014 Elsevier Ltd. All rights reserved.
Professionalism in Osteopathy in the UK
Conclusions: The Professionalism in Osteopathy e-learning resources will be field
tested to explore their potential to guide learning and to track and help to benchmark
the learning curve in pre-registration osteopathic professionalism.
ª 2014 Elsevier Ltd. All rights reserved.
Implications for practice
 Professionalism resources can support teach-
ing and learning of professional behaviours.
Students can recognise that their views about
lapses in professionalism may be different to
others. Students may adapt their own views
following discussion with others.
 Field testing data sets could provide the op-
portunity for comparison of views between co-
horts, educational institutions, faculty health
professionals and patients. Over time, data
sets may be able to track and therefore help
to benchmark the learning curve in pre-
registration osteopathic professionalism in UK
OEIs supporting regulators and other in-
stitutions and groups to target support and
guidance appropriately.
 Discussing different views about lapses in
professionalism could have future implica-
tions for appropriate CPD in the future e
perhaps drawing on feedback from others.
Introduction
The approximately 4900 registered osteopaths in
the UK are regulated by the General Osteopathic
Council (GOsC). Training to be an osteopath usu-
ally takes four years full-time or five years part-
time. There are approximately 800 undergraduate
students enrolled in the 11 osteopathic educa-
tional institutions (OEIs) awarding qualifications
recognised by the GOsC.
In 2011, the GOsC published the Osteopathic Prac-
tice Standards1 the standards which all UK
osteopaths meet for registration. The Osteopathic
Practice Standards identify ‘professionalism’ as
one of the four key domains of osteopathic
practice focussing osteopathic practice on more
than simply knowledge and skills. Professionalism is
a key aspect of the delivery of healthcare to meet
patient and public expectations.2 In 2012, the
GOsC published Student Fitness to Practise:
Guidance for Osteopathic Educational Institutions3
and Student Fitness to Practise Guidance about
Professional Behaviours and Fitness to Practise for
51
Osteopathic Students4 which state that all OEIs are
expected to have published information about the
importance of professional behaviours, how these
are taught and how learning opportunities are
facilitated throughout the course. However, there
are few resources in osteopathy to do this.
A literature review shows that work is emerging in
the field of medical education about the roles of
situational judgement scenarios and e-learning in
identifying gaps in professional behaviours through
responses to particular scenarios. If identified
effectively, such gaps could indicate where addi-
tional regulatory guidance could support more
professional behaviour and could also support the
teaching and learning of professional behaviours.5,6
Indeed, data generated could support the identi-
fication of dissonant views regarding lapses of
professionalism between groups of students,
teachers and others which could support regula-
tors and others involved in osteopathic education
to take appropriate action to support the teaching
and learning of professional behaviours.6
While the research literature on learning, teaching
and assessing professionalism among health pro-
fessionals has proliferated in the last decade,
there have been relatively few attempts to
develop and validate resources that can meet
Gliatto and Stern’s challenge that ‘Delineating the
behaviours and contexts that define professional-
ism can facilitate a staged, level-appropriate cur-
riculum’ (p.263) in undergraduate programmes.7
The GOsC is working to develop such resources
with the 11 UK OEIs to support these aims.
This paper reports the process of determining the
feasibility for two online resources customised for
osteopathy. The resources are based on the Dun-
dee Polyprofessionalism online resources, which
have been developed and tested in the context of
undergraduate medical education and which
collect responses of students and their faculty to
lapses of professionalism.8
Aims
The GOsC publication Student Fitness to Practise:
Guidance for Osteopathic Educational Institutions
notes that ‘Fitness to practise issues may arise
52
prior to, as well as during, the RQ course. The
standards of acceptable behaviour required of a
student prior to and during their course may be
different to those required of registered practi-
tioners. Different standards of behaviour may also
be required from students at different stages of
their course. For example, a fitness to practise
issue which arises in Year 1, prior to any patient
contact, may be treated differently to the same
fitness to practise issue which is identified in the
final year of education and training. A defined
approach to the ways in which learning profes-
sional behaviour will be addressed during the
course is important to assist student understanding
of professional requirements at different points in
the course’.
In order to support the OEIs in their commitment
to teaching and assessing professionalism contrib-
uting to osteopathic practice and community in the
UK, the GOsC aims to develop e-learning tools that
will guide curriculum development through bench-
marking any identified learning curves in the stu-
dent population. This paper reports the early
development process of two such resources,
adapting existing Dundee Polyprofessionalism re-
sources (utilising the same Bristol Online Survey
template) used in medical education, developing
appropriate items for osteopathy and exploring
their potential to ensure that students are taught
and learn about professional behaviours throughout
their undergraduate courses.
Methodology
It was decided after a review of the literature to
adapt the Dundee Polyprofessionalism resources
for UK undergraduate osteopathy, following con-
sent from the developer to do so.
The Dundee Polyprofessionalism e-learning re-
sources have been developed and validated with
medical, nursing and dental students8e10 based on
a multi methods approach similar to that used by
Mulcahy et al,11 including a literature review,
observational studies and consensus strategies
involving stakeholders and experts. The Dundee
Polyprofessionalism e-learning resources are now
being used in the UK and several other countries to
support professionalism learning in the academic
integrity and ‘proto-clinical’12,13 stages of early
patient exposure in clinics and wards and surgeries
as a learner. The educational principles of the
Dundee Polyprofessionalism resources are set out
in Roff’s discussion of ‘Formative Calibrated
Feedback Loops’.14
F. Browne et al.
In order to identify appropriate items for
osteopathy professionalism, the project lead
convened a consensus meeting of two senior
faculty representatives nominated by their Deans
or Principals from each of the 11 OEIs in
February 2012 and senior officers from the GOsC
with expertise in standards. This expert group of
senior stakeholders reviewed the items of the
two Dundee Polyprofessionalism resources for
their relevance for osteopathy in pairs and then
pooled discussion.
Following the round-table consensus process,
the agreed items and wording were circulated in
an online draft format (using Bristol Online Survey
template) and refined on the basis of feedback
which asked one nominated individual from each
of the 11 OEIs to consider:
‘a. Should a version of this item be included in the
osteopathic inventory?
b. Should this item be reworded for osteopathy?
c. If yes, please suggest wording in relation to
each of the proposed items.’
The British College of Osteopathic Medicine
secured ethical permission to pilot the resources,
identified below at Figs. 1 and 2, before the end of
the 2011e2012 academic year. Piloting took place
with undergraduate students during June to
September 2012.
This process was similar to that undertaken by
Mulcahy et al11 with 6 osteopaths and 4 patients to
establish item validity for their patient satisfaction
questionnaire.
Data obtained from osteopathy students was
compared to data obtained from other healthcare
professional students as part of the analysis
undertaken.
Results
In the consensus process, consisting of a round-
table meeting and subsequent online feedback,
the expert group agreed that all the existing items
were appropriate for inclusion, though requiring
some minor modifications of language. Four addi-
tional items were also suggested for inclusion
especially in the area of responsible use of social
media which had emerged as an issue since the
development of the Dundee inventories.
The responses to the survey undertaken
following the consensus meeting mirrored those at
the meeting. The items were finalised with minor
modifications of language to suit the osteopathic
Professionalism in Osteopathy in the UK 53

The survey asks you to rate your responses to the following 34 statements:

1. Getting or giving help for course work, against a teacher's rules (e.g. lending work to another student to

look at)

2. Removing an assigned reference from a shelf in the library in order to prevent other students from

gaining access to the information in it

3. Signing attendance sheets for absent friends, or asking classmates to sign attendance sheets for you

in clinics or lectures

4. Drinking alcohol over lunch and interviewing a patient in the afternoon

5. Exchanging information about an exam before it has been taken (e.g. OSPE)

6. Forging a clinical tutor's signature on a piece of work, patient record, grade sheet or attendance form

7. Claiming collaborative work as one's individual effort

8. Altering or manipulating data or findings (e.g. to obtain a significant result or disguise mistakes)

9. Failure to follow proper infection control procedures

10. Threatening or verbally abusing a university or college employee or fellow student

11. Attempting to use personal relationships, bribes or threats to gain academic advantages by e.g.

getting advance copies of exam papers or passing exam by such pressures on staff

12. Engaging in substance misuse (e.g. drugs)

13. Completing work for another student

14. Intentionally falsifying test results or treatment records in order to disguise mistakes

15. Physically assaulting a university or college employee or student

16. Purchasing work from a fellow student or internet etc. supplier

17. Lack of punctuality for classes or clinics

18. Providing illegal drugs to fellow students

19. Not doing the part assigned in group work

20. Examining patients without knowledge or consent of supervising clinician

21. Sabotaging another student's work

54 F. Browne et al.

22. Inventing extraneous circumstances to delay sitting an exam

23. Sexually harassing a university employee or fellow student

24. Resubmitting work previously submitted for a separate assignment or earlier degree

25. Plagiarising work from a fellow student or publications/internet

26. Cheating in an exam by e.g. copying from neighbour, taking in crib material or using mobile phone or

getting someone else to sit for you

27. Cutting and pasting or paraphrasing material without acknowledging the source

28. Damaging public property e.g. scribbling on desks or chairs

29. Falsifying references or grades on a curriculum vitae or altering grades in the official record

30. Involvement in paedophilic activities - possession/viewing of child pornography images or molesting

children

31. Photographing dissection or prosection or cadaver materials

32. Joking or speaking disrespectfully about bodies/body parts

33. Inappropriate representation of Osteopathy in social media by posting photos/videos/texts about class

or clinic activities

34. Posting inappropriate material about fellow students, teachers or patients on social media

Statements 1 - 34 seek responses a - e

a. Is this wrong?

Yes, No, Unsure

b. Do you think your fellow students do this?

Yes, No, Unsure

c. Have you ever done this in your present course?

Yes, No, Unsure

Professionalism in Osteopathy in the UK 55

d. Would you ever do this in your present course?

Yes, No, Unsure

e. What level of sanction (1-10) should apply for a first time offence with no mitigating circumstances?

1 = None

2 = Reprimand (verbal warning)

3 = Reprimand (written warning)

4 = Reprimand, plus mandatory counselling

5 = Reprimand, counselling, extra work assignment

6 = Failure of specific class/remedial work to gain credit

7 = Failure of specific year (repetition allowed)

8 = Expulsion from college (readmission after one year possible)

9 = Expulsion from college (no chance for readmission)

10 = Report to professional regulatory body

Fig. 1 Professionalism in Osteopathy 1 (Academic) Inventory incorporating statements and views on sanctions.

context. Additional items about social media were
also confirmed.
Professionalism in Osteopathy 1 (Academic)
Four first year students tested the Professionalism
in Osteopathy 1 (Academic) Resource. There was
an appropriate range of responses even within
such a small sample compared to published profiles
of medical student responses.5 They reported no
problems with the wording or the length or the
design of the resource. The 34 items of the Pro-
fessionalism in Osteopathy 1 (Academic) inventory
were confirmed as set out in Fig. 1.
Professionalism in Osteopathy 2 (Clinical)
Twelve third and fourth year students from the
same OEI tested the second programme, with equal
numbers of women and men. All were over the age
of 20 years. As with the first programme, there were
no reported problems with length, design or content
of the programme although not all questions were
responded to by all 12. The 45 items of the
Professionalism in Osteopathy 2 (Clinical) pro-
gramme were confirmed as set out in Fig. 2.
The responses were well-distributed as can be
seem from the five types of items below.10 In Fig. 3
the recommended responses to inappropriate
clothing were clustered at the lowest levels of
‘Ignore’ or ‘Challenge the person about their
behaviour/attitude’.
Fig. 4 shows agreement about the poor profes-
sionalism of discussing patients in public places
and a strong consensus about addressing it directly
with the person.
Figs. 5 and 6 show a clear distinction between
the severity with which inappropriate social media
postings relating to oneself/peers and those
relating to patients/carers are viewed although
there is not a clear consensus about recommended
responses for the latter, which may indicate a
need for clearer guidance from the regulator.
The responses to the questions relating to data
fraud shown in Fig. 7, where a third of the 12 re-
sponders would be willing to ignore it may also
indicate priority areas of teaching for both the OEI
and the regulator.
56 F. Browne et al.

The survey asks you to rate your responses to the following 45 statements:

1. You see one of your fellow students stealing items from the clinic

2. A fellow student doesn't maintain personal hygiene

3. A fellow student undertakes unsupervised procedures beyond what you know is their level of training

4. A fellow student wants to talk about an examination e.g. OSPE that you are not supposed to discuss

5. A fellow student lacks empathy towards patients/carers

6. A fellow student fails to attend as required to a patient because of prejudice about his/her

religion/ethnicity/race.

7. You see one of your fellow students driving a car alone when you know they don't yet have a license

8. A fellow student wants to use your essay material or work you submitted in a previous course as their

own.

9. A fellow student smells of alcohol at the clinic

10. A fellow student is selfish and uncollaborative in group learning either by dominating the group or not

contributing

11. A fellow student asks you to help cover up a mistake in patient record keeping/care.

12. A fellow student offers to give you illegal drugs to help with stress/sleep deprivation

13. One of your fellow students regularly ignores infection control procedures and says they aren't worth

bothering about

14. A fellow student makes rude remarks about a body donated for anatomy dissection

15. A fellow student monopolises library material and/or group discussions

16. A fellow student is very prejudiced about patients' and carer's life styles or diseases

17. A fellow student avoids learning opportunities involving communicable diseases

18. One of your fellow students pretends to be more qualified than they are when dealing with patients

and carers

19. A fellow student bullies colleagues or patients or carers

20. A fellow student offers what you know to be a false excuse to postpone an examination on

compassionate grounds.
Professionalism in Osteopathy in the UK 57

21. A fellow student is paying another classmate to sign the register for classes / clinics they don't attend.

22. A fellow student belittles patients and their carers to their faces.

23. You are aware that one of your fellow students has not informed the institution of a notifiable health

condition

24. A fellow student uses derogatory language about a patient/carer to their face or in discussions with

peers.

25. A fellow student claims to have a better academic record than you know they have achieved.

26. A fellow student is over-empathetic to patients without regard to health resource restrictions or

boundary maintenance

27. A fellow student is clearly under the influence of recreational drugs when they arrive in the clinic.

28. A fellow student harms or photographs a cadaver donated for anatomy classes.

29. One of your fellow students comes into the clinic in inappropriate clothing that does not comply with

the clinic dress policies (eg. it is too informal and not very clean)

30. A fellow student is overly critical of everyone else

31. A fellow student offers to sell you drugs to cope with stress/sleep deprivation

32. A fellow student treats other members of the healthcare team and support staff arrogantly and rudely

33. A fellow student easily loses his/her temper under stress in the clinic

34. A fellow student is always missing classes and deadlines because they oversleep or have a part-time

job

35. You see one of your fellow students driving a car when you know they have been banned from

driving.

36. A fellow student discusses a patient in an elevator pub, cafe or other public place

37. A fellow student is very unsupportive of peers when they become stressed

38. A fellow student is very clever about blaming others for mistakes in the clinic

39. A fellow student does not respond well to constructive criticism

40. A fellow student takes advantage of a social connection with a member of the faculty to improve their

grades.

41. A fellow student expresses sexist or ageist or racist views about entitlement to health care.
58 F. Browne et al.

42. A fellow student posts inappropriate material (written or photographic) about himself or fellow students

on social media / internet

43. A fellow student engages in a social media 'friending' relationship with a patient or carer

44. A fellow student falsifies audit or research data in collection or analysis / reporting

45. A fellow student is disparaging about Osteopathy programmes other than the one s/he is on

Statements 1 - 45 seek responses a - d

a. How wrong do you think this behaviour/attitude is? (1 = not very wrong, 5 = very wrong)

1, 2, 3, 4, 5

b. If a student becomes aware of this behaviour/attitude should they in the first instance:

Ignore it

Challenge the person about the behaviour/attitude

Discuss the person's behaviour/attitude with peers to find a way of addressing it

Report the person's behaviour/attitude to a more senior person without trying to address it oneself or with

peers

Take another course of action

If you selected Take another course of action, please specify:

c. How frequently do you think this behaviour/attitude occurs among osteopathy students? (1 = not at all

frequently, 5 = very frequently)

1, 2, 3, 4, 5

d. How frequently do you think this behaviour / attitude occurs among qualified osteopaths? (not relevant

or 1 = not at all frequently, 5 = very frequently)

Fig. 2 Professionalism in Osteopathy 2 (Clinical).

Professionalism in Osteopathy in the UK 59

Fig. 3 Responses to question about inappropriate clothing.

Fig. 4 Responses to question about breach of patient confidentiality.

60 F. Browne et al.

Fig. 5 Responses to question about inappropriate social media or internet postings about themselves or fellow
students.

Fig. 6 Responses to question about inappropriate social media or internet postings about patients/carers or col-
leagues on social media/internet.
Professionalism in Osteopathy in the UK
Fig. 7 Responses to question about falsification of research or audit data.
Discussion
The data gathered, through these programmes,
could enable course managers and the regulator to
monitor institutional profiles of professionalism
teaching and learning, identifying where gaps in the
students’ understanding may need to be addressed
perhaps through a range of mechanisms including
peer group discussion and additional guidance.
Thus, online survey programmes (such as the Bristol
Online Survey (BOS) platform which was used to
develop the Professionalism in Osteopathy re-
sources and the Dundee Polyprofessionalism re-
sources) can be used to develop e-learning
resources for undergraduate teaching, self-
assessment and monitoring in a health profession
such as osteopathy as it has been done with nursing,
dental and medical students. The functions of these
resources permit instant calibration of data and
several forms of analysis using descriptive statistics
as well as inferential statistical analysis. This data
can be used for individual and/or cohort feedback
supporting discussion and learning.
Conclusion
Now that feasibility has been established, the
programmes are being field-tested with larger co-
horts of both students and their faculty in order to
61
investigate how pre-registration professionalism
can be learned and taught in osteopathy pro-
grammes in the UK.
The Professionalism in Osteopathy 1 (Academic)
and 2 (Clinical) inventories can be used for formative
self-assessment comparing to cohort feedback and
provide feedback to individuals and organisations.
As well as their teaching functions, they may be
able to track and therefore help to benchmark the
learning curve in pre-registration osteopathic
professionalism in UK OEIs. In turn, this will allow
the regulator to target support and guidance
appropriately.
Acknowledgements
We are very grateful to all the UK osteopathic
educational institutions who participated in the
development of these tools in partnership with the
General Osteopathic Council.
Author contribution statement
FB and SR conceived the idea of the programme
development. All authors contributed to the
design and planning of the programme. KR ob-
tained ethical approval from her educational
institution and managed recruitment for the pilot.
AC supported data extraction and analysis for SR.
62
SR wrote the first draft of the manuscript sup-
ported by FB. All authors edited and approved the
final version of the manuscript. FB, AC and TW
were employed as a staff members at the General
Osteopathic Council at the time of the submission
of the manuscript. SR was employed as a consul-
tant to the General Osteopathic Council at the
time of submission of the manuscript. KR was
employed as a staff member at the British College
of Osteopathic Medicine.
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